An expensive slate roof with copper flashing was severely damaged by hail. The insurance company’s adjuster and his contracted engineering company agreed that it was damaged by hail … but still refused to pay for the repair.

The insurance company’s adjuster referred to a paragraph written on the third page of a letter that had been sent to the policyholder six months before which totally excluded hail damage to soft metals that did not result in leaks. He told the policyholder that the vast majority of the $69,000 (plus) damage to his roof would have to be paid at his own expense.

The policy holder’s roofing contractor referred him to me for assistance with his claim.

My close examination of the policy, the letter, and the engineer’s report (in addition to localized weather reports) revealed that the exclusion the adjuster used to deny coverage did not take effect until four weeks after the hail storm. Accordingly, his denial of the claim was improper and he owed the insured for the damages.

When I brought this to their attention, the insurance company reluctantly acknowledged their duty to pay. The policyholder will be made whole and the contractor will be able to serve another homeowner in need of his services.

“No” is not always the final answer. Have a licensed public adjuster review your claim before walking away from your money.

Many insured Missouri home owners are caught off-guard, at the time they file a claim and can afford it the least, when they discover that their “deductible” has increased to several thousands of dollars. (The policy’s “deductible” is a dollar amount that is automatically subtracted by the insurance company from any amount that is owed, per occurrence, to the insured as a result of damage or loss to the home.)

When many home owners first insured their homes, their policies originally had a $500.00 deductible that eventually changed to $1,000. Now, with recent renewals, insurance companies have begun to assign a deductible amount that represents a percentage of the total value of the policy. By this, if a home is insured for $300,000, a 1% deductible allows for each claim to carry a deductible amount of $3,000. This means that a claim against the policy for a $7,000 to repair will result in a payment of $4,000.

A recent Missouri client was surprised and upset to learn that his deductible had increased from its original $1000 to over $5,000 when he filed what was his very first claim after decades of coverage. While we were able to successfully negotiate an agreement with his insurer to waive this deductible amount for his claim, this was an exception to the rule that is not always available – as was the case of another client who discovered too late that she had a significant $2,300 amount to be deducted from her settlement of $6,400.

These increases in the deductible amounts are reported to the home owner at policy renewal on the “Declarations” page that is sent at the time of each renewal. Unfortunately, many home owners will simply file this important page with their policies without reading and noting the change.

Take the time, today, to read your most recent declarations page to see if your deductible has changed. It is possible to negotiate a lower deductible with your insurance company, in some cases, with a slight increase in your premium … but this must be done and in effect PRIOR to the date of any loss or damage.

When your home has been partially or totally destroyed from a peril covered by your insurance contract or policy, you have the right to expect to receive financial support from the insurer toward restoring your home to the condition that it was prior to the loss.

The only fair amount that an insurance company should pay for loss to real property (and that an insured should expect to be paid) is the cost for repair and restoration work that the specialists who undertake the project agree to work for. Sometimes, insurance contracts will allow for reasonable depreciation … but the figure from which the depreciation is made or settlement is awarded should be the actual cost of restoring the property and not an arbitrary estimated amount.

Sometimes, their adjusters who work on their behalf will encourage home owners to agree to settlements that will provide less than what they are entitled to and that can appear to be reasonable … but are not.

For instance, many insurance company adjusters will rely upon and use computer software or publications that claim to represent costs for various incidents, materials and tasks and that are periodically updated by telephone surveys. The errant suggested costs from these computer programs are what the insurance company’s adjusters will often use to base their settlement offers.

These estimating applications are often incomplete, inaccurate and unreliable and will likely be used to represent the company’s first offer of settlement. Unsuspecting home owners will feel obligated to accept these lowball offers … particularly when they are in a hurry for cash.

Sometimes, the insurance company will hire retired or former contractors and will pay them to provide “estimates” for repairing or restoring the home. Many of these folks have not been directly involved with the actual repair or restoration process for many years and lack current knowledge of material costs and procedures. They are also unlikely to be the professionals who are going to be performing the actual work. Additionally, being paid by the insurance company for their bid and their future referrals provides some of these folks with an incentive to provide low and unrealistic “estimates”.

Sometimes the insurer will offer a lump sum “cash out” that will (with quick and fast money) provide the home owner with the enticement to accept a fast settlement that will provide less than the required amount to fully restore their home to the original condition. The idea of lower payments for “do-it-yourself” repair work provides the insurer with a lower payment while leaving the home owner on his own to seek and use lower quality and cheaper materials, inexperienced labor and with no warranty on the final work. This is never a good idea.

Remember, the only fair fair amount that an insurance company should pay (and that you should accept) is the price for repair and restoration work that the specialists who undertake the project agree to work for.

If you feel that you have been underpaid for a recent claim and you live in the State of Missouri, contact me. I will be happy to review your claim and let you know if there are additional steps that can be taken to assist you in receiving all that you are entitled to from your insurance company as a result of your loss.